Cervical Spine Surgery, Pain Management
Conditions
Keywords
ESP, PAIN, Posterior cervical surgery
Brief summary
Posterior cervical spine surgery, often performed on older individuals with significant comorbidities, is one of the most painful surgical operations. Anesthesiologists face a unique challenge in managing pain following these surgeries,Erector spinae plane block (ESPB) is a relatively novel block and was first described for chronic thoracic neuropathic pain in 2016.Cervical erector spinae plane (ESP) block has been described to anesthetize the brachial plexus (BP), however, the mechanism of its clinical effect remains unknown. As the prevertebral fascia encloses the phrenic nerves, BP and erector spinae muscles to form a prevertebral compartment, a local anesthetic injected in the cervical ESP could potentially spread throughout the prevertebral compartment
Interventions
PROCEDUREErector spina plane block (ESP)
The block will be performed in prone position under complete aseptic condition. The site to be blocked will be painted with 5% povidone iodine followed by 70% ethyl alcohol and draped. Linear high-frequency ultrasound probe (7 -15 mhz) (General Electric; GE, LOGIQ E) T1 transverse process will be approached with an 18 G Tuohy's needle in caudal-to-cranial direction. A total of 30 ml of 0.25% bupivacaine was administered deep to erector spinae muscle (ESM) bilaterally.
The block will be performed in prone position under complete aseptic condition. The site to be blocked will be painted with 5% povidone iodine followed by 70% ethyl alcohol and draped. Linear high-frequency ultrasound probe (7 -15 mhz) (General Electric; GE, LOGIQ E) T1 transverse process will be approached with an 18 G Tuohy's needle in caudal-to-cranial direction. A total of 30 ml of 0.25% bupivacaine was administered deep to erector spinae muscle (ESM) bilaterally.
Sponsors
Benha University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* (ASA )classes I and II * patients of either sex * above the age of 18 who will undergo posterior cervical surgery
Exclusion criteria
* patient's refusal to participate * any contraindications to peripheral nerve blocks * history of ischemic heart disease * patients on opioids for chronic pain * patients with significant cognitive impairment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Visual analogue scale | VAS scores at rest and on passive neck movement postoperatively at 0, 2, 4, 6, 8, 12, 24 and 48 hours | Visual analogue pain score which scales from zero (no pain) to ten (unbearable pain). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diaphragmatic Excursion | Baseline (pre-induction), 30 minutes after recovery in PACU, and 24 hours postoperatively. | Diaphragmatic excursion will be measured using B-mode and M-mode ultrasonography during quiet breathing. Excursion is defined as the craniocaudal displacement of the diaphragm dome during tidal respiration. |
| Opioid Consumption | Intraoperative period and first 24 hours postoperatively. | Total intraoperative fentanyl consumption and cumulative morphine consumption during the first 24 postoperative hours. Time to first rescue analgesic request will also be recorded. |
| Pulmonary Function | Baseline (preoperative), 2 hours, and 24 hours postoperatively. | Pulmonary function will be assessed using spirometry to record forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁). |
| Postoperative Pain Over Time (Visual analogue scale ) | Baseline (preoperative), 30 minutes, 2, 6, 12, and 48 hours postoperatively | VAS pain scores at rest will be recorded at predefined postoperative intervals to evaluate pain trajectory. |
| Block-Related Adverse Events | 48 hours post-operatively | Incidence of block-related adverse events, including desaturation, dyspnea, local anesthetic systemic toxicity, hematoma, or nerve injury. |
| Length of Hospital Stay | 48 hours postoperatively | Duration of postoperative hospitalization measured in days. |
| Patient Satisfaction | 48 hours postoperatively. | Patient satisfaction with postoperative analgesia will be evaluated using a 5-point Likert scale (1 = very unsatisfied, 5 = very satisfied). |
Countries
Egypt
Outcome results
None listed